直接抗病毒药物未增加慢性HCV感染者肝细胞癌的发生率

Whether antiviral therapy can reduce the incidence of hepatocellular carcinoma in patients with chronic HCV infection

2010年研究发现慢性HCV感染者经治疗获得持续病毒学应答意味着治愈,全球范围内IFN联合利巴韦林的总体治愈率为60%左右,中国的真实世界研究结果为71.1%。2013年以后,美国率先上市针对HCV的直接抗病毒药物(DAA),治愈率提高至接近100%。然而,近期有研究发现应用DAA后肝细胞癌的发生率有所升高,DAA是不是元凶目前仍有争议。笔者认为这主要是DAA的适应证覆盖了更多且疾病程度更重的终末期丙型肝炎患者所致,而这部分患者本身就是肝细胞癌的高危人群;亦不能完全排除DAA可导致机体抑癌免疫状态发生改变,未来需要从分子水平进行确证。

In 2010,studies found that achievement of sustained virologic response after treatment in patients with chronic HCV infection meant cure; the overall cure rate of interferon combined with ribavirin around the world was about 60%,and the result of real-world study in China was 71. 1%. In 2013,the US took the lead in launching the direct-acting antiviral agents（DAAs） for HCV,and the cure rate was increased to almost 100%. However,recent studies have found that the incidence of hepatocellular carcinoma（HCC） tends to increase after the application of DAAs,and there are still controversies over whether DAAs are the major cause of this phenomenon. In our opinion,this phenomenon is caused by the fact that the indications for DAAs cover more end-stage hepatitis C patients who are intrinsically the high-risk population of HCC; however,it cannot be excluded that DAAs may lead to the change in the body＇s antitumor immune status. Studies are needed in the future to examine this issue at the molecular level.